Cushings or not?

[ping1958]

Hi, my 12 year old mini dachshund has a wee infection, she is on antibiotics, she wees every waking moment and then wakes umpteen times in the night (probably about 30 times a day), she drinks a lot, her skin is paper thin, she has patches of fur missing both sides of her trunk, she eats food like it's her last meal and tries to steal food, she has a drooping belly, she also has ear infections and is carrying a lot more weight than she used to even though food intake has been reduced by me. Wee infections have been on and off for the last year. Urine has been tested - dilute and with protein, and then further tests shows presence of blood with both white and red cells. Blood tests performed and showed high ALP level, elevated potassium, high urea. Ultrasound scan done and showed liver good, kidneys good but showing a little fluid around them. ACTH Stimulation Test done, results for Addisons and Cushings normal. So, my question is, with all these symptoms of Cushings how come the test comes back saying she doesn't have Cushings? Could it be Atypical Cushings? Your thoughts would be greatly appreciated.

[Joan2517]

Hello and welcome. She sure has a lot going on. Has she been on prednisone at all? Or any kind of steroids? Could you post the results of the blood work? Members more knowledgeable than I am will be along to welcome you as well and will want to see the numbers.

What is her name?

[Joan2517]

They will want to see the actual numbers of those results that are out of range, if you can post those along with the reference ranges it will give them a better understanding of what might be going on.

[ping1958]

Hello, her name is Lola. She has been on pred. umpteen times in her little life. She is now 12 and when she was 5 had back surgery for a crushed disc, when she lost the use of her back legs. After six months cage rest and medication she recovered almost fully. In the following seven years she has had the odd hitch and had to take steroids again and in the last eighteen months she has had a fit, haemoraged both her eyes (due to being muzzled at the vet), umpteen wee infections, allergy testing (allergic to potato and sugar beet), so change of diet, further wee infections with blood, and now weeing for England. She has been on pred. several times in the last eighteen months. They tried anti-inflammatories (Metacam) for her weeing but no effect. I don't have access to her test results but from peering over the vet's shoulder the wee pH was 5 and showing as dilute. Apparently the liver test was considered to be the top end before they start testing for something.

[labblab]

Hello and welcome from me, as well! I apologize that I have only a moment to write, but learning more specifics about the duration and also how recently your little girl was taking prednisone will be helpful to us. As you probably know, prednisone itself can result in the symptoms that are consistent with Cushing's.

However, if she's been free of any prednisone for a while now, I'd suggest that the vet perform an alternative diagnostic blood test for Cushing's: the LDDS (Low Dose Dexamethasone Suppression test). It tests a different aspect of adrenal function than does the ACTH, and is less likely to "miss" making a positive diagnosis in a dog who truly has Cushing's. The ACTH returns a signifcant number of "false negatives," especially in dogs that suffer from adrenal tumors. So if the prednisone is not a consideration, I'd ask my vet for a LDDS test.

Marianne

[judymaggie]

Hi and welcome to you and Lola! It sounds like you have had your hands full over the years with dealing with Lola's health issues and am sure you are troubled to be in the position of trying to figure out what is going on now. Kudos to you for taking such good care of her!

As Joan has advised, it would help us a great deal to see the actual test results that were high or low. For example, "ALP 65 (range, 20-40)" along with the date of the test. You mentioned dilute urine and protein in the urine. Please post the exact specific gravity along with the range the number after the protein, i.e., 3+. With regard to the ACTH, there would be two numbers, a pre- and a post- (if you are in the U.S.; I believe in Europe, there would be three numbers).

Is there any mention of the adrenal glands on the ultrasound? One strong indication of Cushing's is the state of the adrenal glands, i.e., enlarged or not. Has your vet expressed any opinion about the fluid found in the abdomen? Is your concerned about the elevated potassium?

We look forward to learning more about Lola so we can help guide you in your hunt for answers.

[ping1958]

Hi, I will attempt to get a read out of the results when next at the vet next week. All she mentioned of the ultrasound were the kidneys and liver being good, with a small amount of excess fluid around the kidneys but she didn't seem troubled by that she said they were of a good size, etc., as was liver. When Lola is asleep she does not wee, when she is awake she can do a normal wee and should I "disappear" out of her sight, she barks and does a small wee, and this could be every few minutes. It appears she has acute separation anxiety. Last night she wee'd at 7 p.m. then went to sleep and got up at 11.30 p.m. to wee. Went back to bed and it was 5.30 a.m. before the next one. However, once up at 7.30 a.m. and has her breakfast, I went to have a bath and came back to find she had wee'd twice more, but now been asleep for four hours and nothing. This is another reason I am swinging towards Cushings as it seems to be related to panic. when she can't see me. Last prednisone was spring of last year. She is also approx. 2kg. over her best weight. This recent turn of events began in September 2015 when she had an unexpected fit and, following her vaccinations in November 2015 everything has changed, i.e. the weight gain, the itching skin, damaged skin, ear problems, wee problems, etc. Last year was spent trying to get to the bottom of it and they came up with food allergies. One thing at least is that she is still a happy doggy who loves her cuddles. If the excessive weeing isn't doing her any harm then I am more than happy to mop up after her - she is my world. Anyway, thank you so much for coming back to me. I will endeavour to get the figures and let you know. I will also enquire as to whether the ultrasound found any problems with the adrenals.

[Squirt's Mom]

Dog who are anxious or who suffer separation anxiety often pee as a result. This anxiety, or panic, is not typically associated with Cushing's urination. They are two different things. ;) A cush pup can be restless or even anxious...but once the cortisol is controlled that goes away. Separation anxiety is a psychological/behavioral disorder, not physiological tho illnesses may cause the same signs. Confusing, huh? :) So if you think separation anxiety is in play, I would address that first and see if anything changes. Cushing's does not typically come on quickly or following events or procedures like vaccines - it take years for most of us to recognize the changes...we think our babies are simply getting older and changing as a result. So the first thing I would concentrate on is ruling out all these other possibilities before I spent money on cush testing and certainly before I started any treatment for Cushing's. The drugs used to treat Cushing's are powerful and should be started only when it is pretty clear Cushing's is in play. One other thing to keep in mind - a dog who is easily stressed can produce false positives on the cush tests...so rule all these other things out first and if it turns out she really does have anxiety separation or any other anxiety disorder, do your best to get that under control. This is what I would...tho others may disagree and have other thoughts. ;)

Hugs,
Leslie and the gang

[molly muffin]

Hello from me too. Well urinary track infections cause them to wee much more and more often, just as it does in humans. Have they did a culture to determine what type of bacterial is causing the infections and if they are completely cleared up each time? I'm wondered about an ecoli bacteria which can require a dog be on antibiotics sometimes for 30 days or more for it to clear up and if it isn't confirmed clear with a culture often comes right back. So something to talk to vet about. Also to make sure that the right antibiotic for the type of infection is being given.

I think between us we have thrown out a lot of suggestions for to discuss with your vet. Make a list, as I'm sure I would forget half of it when I actually am in the vet office, then go through each item and possibility with the vet.

We will be looking forward to seeing actual test numbers and see if we can't give you some feed back based on those results.

Welcome to the forum